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Abnormalities of the major intrathoracic arteries in Turner syndrome as revealed by magnetic resonance imaging
- Kristian Havmand Mortensen, Britta Eilersen Hjerrild, Niels Holmark Andersen, Keld Ejvind Sørensen, Arne Hørlyck, Erik Morre Pedersen, Erik Lundorf, Jens Sandahl Christiansen, Claus Højbjerg Gravholt
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- Journal:
- Cardiology in the Young / Volume 20 / Issue 2 / April 2010
- Published online by Cambridge University Press:
- 22 March 2010, pp. 191-200
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Background
Ectatic aortopathy and arterial abnormalities cause excess morbidity and mortality in Turner syndrome, where a state of vasculopathy seemingly extends into the major head and neck branch arteries.
ObjectiveWe investigated the prevalence of abnormalities of the major intrathoracic arteries, their interaction with arterial dimensions, and their association with karyotype.
DesignMagnetic resonance imaging scans determined the arterial abnormalities as well as head and neck branch artery and aortic dimensions in 99 adult women with Turner syndrome compared with 33 healthy female controls. Echocardiography determined aortic valve morphology.
ResultsIn Turner syndrome, the relative risk of any congenital abnormality was 7.7 (p = 0.003) and 6.7 of ascending aortic dilation (p = 0.02). A bovine aortic arch was seen in both Turner syndrome and controls. Other abnormalities were only encountered in Turner syndrome: elongated transverse aortic arch (47%), bicuspid aortic valve (27%), aortic coarctation (13%), aberrant right subclavian artery (8%), and aortic arch hypoplasia (2%). The innominate and left common carotid arteries were enlarged in Turner syndrome (p < 0.001). Significant associations were first, bicuspid aortic valve with aortic coarctation, elongated transverse aortic arch, and ascending aortic dilation; second, aortic coarctation with elongated aortic arch and descending aortic dilation; third, 45,X with aortic coarctation, elongated transverse aortic arch and ascending aortic dilation; and fourth, branch artery dilation with bicuspid aortic valve, aortic coarctation, elongated transverse aortic arch and 45,X.
ConclusionAn increased risk of arterial abnormalities, aortic dilation, and enlargement of the branch arteries was found in Turner syndrome without distinct patterns of co-segregation.
Clinical and epidemiological description of aortic dissection in Turner's syndrome
- Claus Højbjerg Gravholt, Kerstin Landin-Wilhelmsen, Kirstine Stochholm, Britta Eilersen Hjerrild, Thomas Ledet, Christian Born Djurhuus, Lisskulla Sylvén, Ulrik Baandrup, Bent Østergaard Kristensen, Jens Sandahl Christiansen
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- Journal:
- Cardiology in the Young / Volume 16 / Issue 5 / October 2006
- Published online by Cambridge University Press:
- 20 September 2006, pp. 430-436
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Background: Women with Turner's syndrome have an increased risk of congenital cardiac malformations, ischaemic heart disease, hypertension and stroke. Aortic dissection seems to occur with increased frequency. Aim: To describe in more detail aortic dissection as encountered in Turner's syndrome, giving attention to clinical, histological and epidemiological aspects. Materials and methods: Based on a retrospective study, we describe the clinical, karyotypic, and epidemiological aspects of aortic dissection as encountered in cases of Turner's syndrome seen in Denmark and Sweden. Results: The median age at onset of aortic dissection in 18 women was 35 years, ranging from 18 to 61 years. Fourteen of 18 women had a 45,X karyotype, while 2 patients had 45,X/45,XY, and 2 had the 45,X/46,X+r(X) complement, respectively. Echocardiography was performed in 10 of 18 patients before their acute illness, and showed signs of congenital cardiac disease, with either bifoliate aortic valves, dilation of the aortic root, or previous aortic coarctation evident in most patients. In 5 patients evidence of a bifoliate aortic valve was conclusive. Hypertension was present in 5 of 18 patients, while 10 of the patients died from aortic dissection, of so-called type A in 6, type B in 3, while in the final case the origin of dissection could not be determined. Biochemical analysis showed altered ratio between type I and type III collagen. Histology showed cystic medial necrosis in 3 of 7 cases. We estimated an incidence of dissection of 36 per 100,000 Turner's syndrome years, compared with an incidence of 6 per 100,000 in the general population, and a cumulated rate of incidence of 14, 73, 78, and 50 per 100,000 among 0–19, 20–29, 30–39, and 40+ year olds, respectively. Conclusion: Aortic dissection is extremely common in the setting of Turner's syndrome, and occurs early in life. Patients with Turner's syndrome should be offered a protocol for clinical follow-up similar to that provided for patients with Marfan syndrome, and each clinic should embrace a programme for follow-up.
10 - Growth hormone and body composition
- from Part III - Growth hormone replacement therapy in adults with growth hormone deficiency
- Edited by Anders Juul, National University Hospital, Copenhagen, Jens O. L. Jorgensen, Aarhus Kommunehospital, Aarhus, Denmark
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- Book:
- Growth Hormone in Adults
- Published online:
- 08 January 2010
- Print publication:
- 27 April 2000, pp 222-232
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Summary
Introduction
The anabolic and lipolytic effects of growth hormone (GH) and thereby the effects upon muscle and fat tissue have been known for many years. Already in 1934, increased muscle mass and reduced body fat was reported in rats after administration of anterior pituitary extracts (Lee & Shaffer, 1934). In children, where GH replacement therapy was introduced in 1957, it was soon observed that GH administration not only affected skeletal growth, but also significantly changed body composition (Tanner & Whitehouse, 1967). In GH-deficient adults the first controlled clinical trials on the effect of GH treatment also reported profound effects on muscle and fat mass (Jørgensen et al., 1989; Salomon et al., 1989). The subsequent – and still ongoing – discussions about whether or not GH-deficient adults should be offered GH replacement therapy have to some extent focused on the beneficial effects on body composition. It has been argued that many of the beneficial effects reported after GH replacement therapy in adults are ‘cosmetic’ and do not justify that this expensive treatment should be offered on a routine basis. The effects on body composition should, however, not be seen as an isolated phenomenon, but rather as the integrated results of the well documented metabolic actions of GH – described elsewhere in this volume. Furthermore, there exists a rather complex relationship between ageing, body composition and GH secretion, which is important to take into consideration in the diagnostic process in elderly patients suspected for GH deficiency (GHD).
Assessing and monitoring body composition, therefore, has become an important clinical tool in the management of adult GHD.